Period Health 101: Everything You Should Have Learned in 6th Grade, But Didn’t… Part 2 of 3

In Female Pelvic Pain by Jandra MuellerLeave a Comment

By Jandra Mueller, DPT, MS, PHRC Encinitas


In case you missed it, here is Period Health 101: Everything You Should Have Learned in 6th Grade, But Didn’t, Part 1.


What are your hormones doing throughout the various phases?

To understand this, refer to the chart below. It is actually helpful in understanding the hormonal shifts throughout the various phases of your cycle and how these hormonal shifts affect your body.


Credit to Vios Fertility Institute

This chart is referring to someone with an average 28 day cycle, so if your cycle is shorter or longer, these phases will also shift. At the bottom of the chart it is depicting the days of your cycle from day zero to day 28. Day one through seven is your menses or your period. Day zero to 14 is your follicular phase, your menses fall into this range, day 14 is ovulation, and day 15 to 28 is the luteal phase. 


In the column above this, you are looking at the lining of the uterus, followed by the ovarian hormones, the pituitary hormones, body temperature, and events in the ovary. 


From day one through seven the egg that was not fertilized gets shed out of your body along with the uterine lining, and your sex hormones (estrogen and progesterone) are at their lowest levels. This is what stimulated the shedding of your lining and your period in the first place. At the same time, your pituitary gland is releasing low levels (of varying amounts) of LH and FSH which is stimulating the ovarian follicles to mature and create a new dominant follicle which will go on to release an egg at ovulation.


 As the follicle grows and matures, it is releasing estradiol so you can see that begin to rise during day 10 to 14 and you may notice some of that cervical mucus or fertile mucus as discharge during this time; this is getting into your fertile time. Beginning around day 11, you see that your LH begins to steadily rise and peak at about day 13 or 14 and drop suddenly. This is what stimulates the follicle to release an egg, the event of ovulation. There is also a peak of FSH at this time. LH may continue to rise even if you don’t ovulate for various reasons, so if you are using ovulation strips, you may see this peak, but still not ovulate.


On day 14, once the follicle releases the egg, that follicle now quickly changes and in four short days, it is a completely different structure with its own blood supply and is the only structure producing progesterone. As Dr. Lara Briden reminds us in her book many times, if you don’t ovulate, you do not produce progesterone. Your body temperature spikes at ovulation because progesterone helps to elevate body temperature and this is in part thanks to your thyroid gland. This is the basis of taking your temperature every morning before you get up when you practice the fertility awareness method which we will discuss in a later blog. 


After ovulation, your estrogen levels lower somewhat but progesterone continues to elevate until the very last days and then they both dip down to low levels if pregnancy does not occur. The drop in these hormones then signals the uterine lining to become thin and shed and you are back at day one, your period. This cycle will continue to repeat itself until it is disrupted with pregnancy, menopause, hormonal birth control, or other conditions.


So, that is normal. There are SO many factors that make this process run efficiently and deficiencies or excess can cause problems. So before you run to your doctor and get on OCPs to regulate your period, take a look at the chart below and see where exactly you’re having issues, track your cycle, and be a detective and gain more insight as to the possible causes of why you are having these issues in the first place. 

Click here to continue reading part 3 of this blog!



  1. Briden L, Prior JC. Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. Place of publication not identified: Greenpeak Publishing; 2018. 



Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $85.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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